@article{ref1,
title="Predictors of prolonged opioid use after initial prescription for acute musculoskeletal injuries in adults: a systematic review and meta-analysis of observational studies",
journal="Annals of internal medicine",
year="2020",
author="Riva, John J. and Noor, Salmi T. and Wang, Li and Ashoorion, Vahid and Foroutan, Farid and Sadeghirad, Behnam and Couban, Rachel and Busse, Jason W.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Opioids are frequently prescribed for acute musculoskeletal injuries and may result in long-term use and consequent harms.   PURPOSE: To explore factors associated with persistent opioid use after its prescription for acute musculoskeletal injury.   DATA SOURCES: Searches of multiple electronic databases, without language restrictions, from inception to 6 January 2020, and reference lists of selected articles.   STUDY SELECTION: Observational studies of adults with opioid prescriptions for outpatient acute musculoskeletal injuries, in an adjusted model, that explored risk factors for prolonged use.   DATA EXTRACTION: 6 reviewers, working in pairs, independently extracted data, rated the quality of studies, and evaluated the certainty of evidence.   DATA SYNTHESIS: 14 cohorts with 13 263 393 participants were included. The overall prevalence of prolonged opioid use after musculoskeletal injury for high-risk populations (that is, patients receiving workers' compensation benefits, Veterans Affairs claimants, or patients with high rates of concurrent substance use disorder) was 27% (95% CI, 18% to 37%). The prevalence among low-risk populations was 6% (CI, 4% to 8%; P for interaction < 0.001). Moderate-certainty evidence showed increased odds of persistent opioid use with older age (absolute risk increase [ARI] for every 10-year increase, 1.1% [CI, 0.7% to 1.5%]) and physical comorbidity (ARI, 0.9% [CI, 0.1% to 1.7%]). Low-certainty evidence suggested increased risk for persistent opioid use with past or current substance use disorder (ARI, 10.5% [CI, 4.2% to 19.8%]), prescriptions lasting more than 7 days (median ARI, 4.5%), and higher morphine milligram equivalents per day.   LIMITATION: Sparse, heterogeneous data with suboptimal adjustment for potential confounders.   CONCLUSION: Avoiding prescribing opioids for acute musculoskeletal injuries to patients with past or current substance use disorder, and restricting duration to 7 days or less and using lower doses when they are prescribed, are potentially important targets to reduce rates of persistent opioid use.   PRIMARY FUNDING SOURCE: National Safety Council. (PROSPERO: CRD42018104968).<p /> <p>Language: en</p>",
language="en",
issn="0003-4819",
doi="10.7326/M19-3600",
url="http://dx.doi.org/10.7326/M19-3600"
}